From the Guidelines
The IDSA guidelines for treating community-acquired pneumonia recommend empiric therapy based on patient setting and risk factors, with a minimum treatment duration of 5 days, as supported by the most recent evidence from 2021 1.
Key Recommendations
- For outpatient treatment of healthy adults without risk factors, amoxicillin 1g three times daily or doxycycline 100mg twice daily is recommended.
- For outpatients with comorbidities, a respiratory fluoroquinolone (levofloxacin 750mg daily or moxifloxacin 400mg daily) or a beta-lactam (amoxicillin-clavulanate 875/125mg twice daily, cefpodoxime 200mg twice daily, or cefuroxime 500mg twice daily) plus a macrolide (azithromycin 500mg on day 1, then 250mg daily for 4 days) is advised.
- For hospitalized non-ICU patients, a beta-lactam (ampicillin-sulbactam 1.5-3g every 6 hours, ceftriaxone 1-2g daily, or cefotaxime 1-2g every 8 hours) plus a macrolide is recommended, as outlined in the 2019 IDSA/ATS guideline 1.
- ICU patients should receive a beta-lactam plus either a macrolide or a respiratory fluoroquinolone.
Treatment Duration
- Treatment duration is typically 5-7 days for most patients, with clinical improvement guiding the decision to discontinue, as supported by the 2021 evidence 1.
- Patients should be afebrile for 48-72 hours and have no more than one CAP-associated sign of clinical instability before stopping therapy.
Pathogen Coverage
- These recommendations aim to provide adequate coverage against common pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms while considering local resistance patterns and individual risk factors for drug-resistant pathogens, as discussed in the 2002 study 1 and the 2019 IDSA/ATS guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
IDSA Guidelines for Community-Acquired Pneumonia (CAP)
The Infectious Diseases Society of America (IDSA) has published guidelines for the treatment of community-acquired pneumonia (CAP) 2. The guidelines emphasize the use of sputum Gram's stain and culture in all patients, whenever possible, to establish etiology.
Diagnosis and Empiric Therapy
- Chest radiographs are strongly recommended to confirm the diagnosis of CAP, particularly in patients requiring hospitalization 2.
- The IDSA guidelines recommend initial empiric antimicrobial therapy until laboratory results can be obtained to guide more specific therapy 2.
- Macrolides, doxycycline, and fluoroquinolones are suggested for primary empiric therapy, as they have activity against common bacterial pathogens and atypical agents 2.
Antibiotic Recommendations
- Detailed antibiotic recommendations are made for various pathogens, including coverage for Legionella and other common pathogenic bacteria in inpatients 2.
- Alternative antibiotics are recommended for patients with structural diseases of the lung, penicillin allergy, or suspected aspiration pneumonia 2.
- Switch to an appropriate oral antibiotic is recommended as soon as the patient's condition is stable and they can tolerate oral therapy, often within 72 hours 2.
Special Considerations
- Patients with risk factors for drug-resistant pathogens (DRPs) may require special consideration, as the IDSA/ATS treatment guidelines do not provide clear recommendations for empiric treatment in this group 3.
- A study found that only 2% of patients with CAP and risk factors for DRPs received an antibiotic regimen with coverage of the specific DRP risk factor present 3.
Adherence to Guidelines
- A study found that adherence to IDSA guidelines for empiric therapy of CAP was variable, with 52.0% of previously healthy patients without recent antibiotic use receiving recommended therapy 4.
- Patients whose therapy was adherent with the guidelines had fewer respiratory-infection-related hospital admissions within 30 days after initiation of antibiotic treatment 4.
Bacterial Etiology and Susceptibility
- A study found that Klebsiella pneumoniae was the most prevalent bacterium in CAP patients, followed by Streptococcus pneumoniae and Pseudomonas aeruginosa 5.
- The study also found that 76.2% of isolates showed a multidrug-resistant phenotype, highlighting the importance of effective empiric antibiotic therapy 5.